Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation.
Immediate- and short-term follow-up results of balloon dilatation of aortic recoarctation following surgery have been well documented, but there is sparse data on long-term follow-up. During a 10-year period ending in August 1995, 33 children, aged 2 months to 14 years old, underwent balloon angioplasty of aortic recoarctation. Prior surgery included resection and end-to-end anastomosis (n = 9), subclavian flap (n = 16) or prosthetic (Dacron or Gore-Tex) patch (n = 5) angioplasty, and repair of an interrupted aortic arch (n = 3). Recoarctation developed 1 month to 14 years (mean +/- SD 29 +/- 44 months) after surgery. The indications for angioplasty were peak-to-peak systolic gradients > 20 mm Hg and systemic hypertension and/or congestive heart failure. After balloon angioplasty, the peak-to-peak systolic pressure gradient across the coarctation decreased from 48 +/- 22 to 13 +/- 15 mm Hg (p <0.01), and the size of the coarcted segment increased from 3.3 +/- 1.4 to 6.5 +/- 2.3 mm (p <0.01). Follow-up angiography and/or magnetic resonance imaging were performed in 20 children 17 +/- 12 months after angioplasty. No aneurysms were observed and improvement in the diameter of the coarcted aortic segment (9 +/- 3 mm) persisted. One- to 10-year (median 5) clinical follow-up was available in 32 children. During follow-up, 2 children required surgery to repair a long tubular isthmic narrowing. The residual gradients, determined by arm-leg systolic blood pressure difference, were 5 +/- 8 mm Hg. No patient was symptomatic and only 1 patient (3%) was hypertensive, controlled with antihypertensive medications. We conclude that balloon angioplasty of aortic recoarctation following all types of surgical repair is feasible, safe, and effective with good long-term results. We recommend balloon angioplasty as the procedure of choice in the management of postsurgical recoarctation with hypertension and/or congestive heart failure.
Siblini
G
G
Department of Pediatrics, Saint Louis University School of Medicine/Cardinal Glennon Children's Hospital, Missouri 63104-1095, USA.
Rao
P S
PS
Nouri
S
S
Ferdman
B
B
Jureidini
S B
SB
Wilson
A D
AD
D000293:Adolescent; D000800:Angioplasty, Balloon / Q000592:standards*; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome